Organization
GENERATIONAL COMPANION CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GWENDOLYN BACON FAIRBANKS (OWNER)
(904) 537-6722
Entity
Organization
Contact information
Practice address
3571 RAIN FOREST DR W, JACKSONVILLE, FL 32277-9320
(904) 537-6722
Mailing address
3571 RAIN FOREST DR W, JACKSONVILLE, FL 32277-9320
(904) 537-6722
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
374U00000X
Home Health Aide
—
—
376J00000X
Homemaker
—
—
Other
Enumeration date
12/02/2021
Last updated
12/02/2021
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